Neonatal fluid and electrolytes profile effect on amphotericin B associated nephrotoxicity in neonatal tertiary care unit of Karachi-Pakistan. Issue 9 (1st September 2020)

• Record Type: Journal Article
• Authors: Ambreen, Gul; Rehman, Arshalooz; Hussain, Kashif; Sohail, Mehreen; Javed, Saba; Shamim, Syed; Ali, Umer; Ahmad, Khalil; Rizvi, Arjumand
• Is Part Of: Expert opinion on drug safety. Volume 19:Issue 9(2020)
• Page Start: 1209
• Page End: 1217
• Publication Date: 2020-09-01
• Subjects: Amphotericin B -- nephrotoxicity -- neonates -- sodium -- potassium -- neonates -- fluid and electrolytes; Drugs -- Side effects -- Periodicals; Drugs -- Toxicology -- Periodicals; Chemotherapy -- Periodicals; 615.704
• DOI: 10.1080/14740338.2020.1781813
• Languages: English
• ISSNs: 1474-0338

Abstract

ABSTRACT: Objectives: Amphotericin-B (d-AmB) has a broader anti-fungal spectrum and is used for neonatal invasive-fungal-infections especially invasive-candidiasis (IC). To prevent d-AmB-induced nephrotoxicity, renal protective effect of fluid and electrolyte management has been established among adults; in this study, the authors determined this effect among neonates. Methods: In this retrospective cohort study, the authors reviewed neonatal medical records, admitted to neonatal intensive care unit and received d-AmB therapy. Patients were divided into, renal-insufficiency-group (RIG) and the non-renal-insufficiency-group (NIG). Results: A total of 90 cases were analyzed, 41 composed RIG and 49 NIG. Renal insufficiency (RI) was developed on 1.7 (0.84) and 7.8 (1.21) days of d-AmB therapy in 26 (63%) and 15 (37%) cases respectively. Bivariate and multivariate analysis demonstrate that >4 m Eq/kg/d sodium intake across all-time points was significantly ( p < 0.0001) associated with reduced risk of RI [(phase-I: AOR: 0.96; 95% CI: 0.91–0.99), (phase-II: AOR: 0.84; 95% CI: 0.68–0.92) and (phase-III: AOR: 0.90; 95% CI: 0.86–0.95)]. While adequate fluid intake reduced the likelihood of RI if started before and initial 2 days of d-AmB therapy. Conclusions: Adequate hydration before and 48 hours after d-AmB therapy and >4 mEq/kg/day sodium intake before and through d-AmB therapy may protect neonatal RI.